Provider Demographics
NPI:1265588347
Name:SMITH, DAVID L (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 EAGLE CREST LOOP
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9698
Mailing Address - Country:US
Mailing Address - Phone:719-275-4536
Mailing Address - Fax:
Practice Address - Street 1:100 S PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226-1431
Practice Address - Country:US
Practice Address - Phone:719-784-3935
Practice Address - Fax:719-784-4686
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice